Prevalence of low bone mass among adolescents with nontransfusion-dependent hemoglobin E/β-thalassemia and its relationship with anemia severity

BACKGROUND

Low bone mass is common among adolescents with transfusion-dependent β-thalassemia despite adequate transfusion and iron chelation. However, there are few reports regarding bone mineral density (BMD) among adolescents with nontransfusion-dependent thalassemia (NTDT). Indeed, only BMD data in patients with nontransfusion-dependent (NTD) β-thalassemia intermedia have been reported. No previous study has investigated BMD among adolescents with NTD hemoglobin (Hb) E/β-thalassemia.

OBJECTIVE

To determine the prevalence of low bone mass among adolescents with NTD Hb E/β-thalassemia and factors relating to low bone mass.

METHODS

We investigated BMD of lumbar spine (L2-L4; BMDLS) and total body (BMDTB), as measured by dual-energy X-ray absorptiometry, in 22 adolescents (aged 13.2-20 years) with NTD Hb E/β-thalassemia.

RESULTS

Low bone mass was found to be 18.2% and 22.7% at the lumbar spine (BMDLS Z-score adjusted for bone age and height age) and 13.6% and 9.1% at the total body (BMDTB Z-score adjusted for bone age and height age). Patients with mean Hb level <8 g/dl were more likely to have low bone mass (BMDLS and BMDTB Z-scores adjusted for bone age) compared to those with Hb level ≥ 8 g/dl. Mean Hb level correlated with BMDLS and BMDTB Z-scores adjusted for bone age.

CONCLUSION

We demonstrated that a low Hb level was associated with low bone mass among adolescents with NTD Hb E/β-thalassemia. A significant proportion of low bone mass among these patients highlights the importance of appropriate management, including red cell transfusion, vitamin D and calcium supplementation for improved long-term bone health.

A normal reference of bone mineral density (BMD) measured by dual energy X-ray absorptiometry in healthy thai children and adolescents aged 5-18 years: a new reference for Southeast Asian Populations

Ethnic-specific normative data of bone mineral density (BMD) is essential for the accurate interpretation of BMD measurement. There have been previous reports of normative BMD data for Caucasian and Asian children including Japanese, Chinese, Korean and Indian. However, the normative BMD data for Southeast Asian including Thai children and adolescents are not currently available. The goals of our study were 1) to establish normative data of BMD, bone mineral content (BMC), bone area (BA) and lean body mass (LBM) for healthy Thai children and adolescents; aged 5–18 years measured by dual energy X-ray absorptiometry (DXA, Lunar Prodigy) and 2) to evaluate the relationships between BMD vs. age, sex, puberty, weight, height, calcium intake and the age of menarche in our population. Gender and age-specific BMD (L2-4; LS and total body; TB), BMADLS (apparent BMD of the lumbar spine), BMC (L2-4 and total body), BA (L2-4 and total body) and LBM were evaluated in 367 children (174 boys and 193 girls). All parameters increased progressively with age. A rapid increase in BMD, BMC and BMADLS was observed at earlier ages in girls. Gender and Tanner stage-specific BMD normative data were also generated. The dynamic changes of BMD values from childhood to early and late puberty of Thai children appeared to be consistent with those of Caucasian and Asian populations. Using a multiple-regression, weight and Tanner stage significantly affected BMDLS, BMDTB and BMADLS in both genders. Only in girls, height was found to have significant influence on BMDTB and BMADLS. The positive correlation between BMD and several demographic parameters, except the calcium intake, was observed. In summary, we established a normal BMD reference for Thai children and adolescents and this will be of useful for clinicians and researchers to appropriately assess BMD in Thais and other Southeast Asian children.

Glycemic control, quality of life and self-care behavior among adolescents with type 1 diabetes who attended a diabetes camp

A prospective study was conducted at the tenth Siriraj diabetes camp with the objectives of evaluating the effectiveness of diabetes camp on 1) glycemic control, 2) knowledge, 3) quality of life, and 4) self-care behavior of adolescents with type 1 diabetes (T1D) who participated in the diabetes camp. During the 5-day camp, twenty-seven participants (mean age 15.6 +/- 2.1 years, mean duration 6.3 +/- 3.0 years) were taught diabetes self-management education (DSME) and engaged in psychosocial support sessions. Post-camp activities were held every 3 months and participants were followed for 12 months post-camp. Glycemic control was assessed prior to the camp, then every 3 months. Knowledge level was assessed prior to the camp, at the end of the camp, and every 3 months. Diabetes self-care behavior and quality of life were evaluated prior to the camp, at 3 months and 12 months after the camp. After attending the camp, participants had improvement in knowledge but there were no changes in HbA1c levels or quality of life scores. Quality of life was not consistently associated with HbA1c. In general, participants did not perceive their quality of life was poor or feel having diabetes affected their social life. The issue participants worried about most was whether they would develop complications from diabetes. There were several weak points found among participant self-care behavior, particularly in diet-related matters. Despite no improvement in glycemic control, participants gained knowledge from attending the camp. Diet related self-care behavior is difficult for teenagers with T1D to be compliant.

Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp

OBJECTIVE

The aim of this study was to evaluate the effectiveness of diabetes camp on glycemic control, knowledge, and psychosocial benefits among patients with type 1 diabetes (T1D). Glycemic control among patients with infrequent and frequent self-monitoring of blood glucose (SMBG) was also compared.

METHODS

During a 5-day camp, 60 patients were taught diabetes self-management education (DSME). After camp, patients were divided into two groups based on frequency of SMBG (<3 versus 3-4 times/day) and were followed up until 6-month post-camp. Patients' HbA1c levels and knowledge were assessed at baseline, 3- and 6-month post-camp. Patients' impressions towards camp were assessed.

RESULTS

In both SMBG groups, HbA1c levels decreased significantly at 3-month post-camp but did not sustain at 6-month monitoring. The patients with frequent SMBG had a lower mean HbA1c level. A significant improvement in knowledge was noted and sustained up to 6-month post-camp. The patients found diabetes camp of benefit and felt they could better cope with diabetes.

CONCLUSIONS

Although the effect of the diabetes camp on glycemic control was short-lived, an improvement in knowledge and a better attitude towards having diabetes were seen among participants.

PRACTICE IMPLICATIONS

The psychosocial benefits and knowledge gained by patients attending diabetes camp underline the importance of including a camp in a diabetes management plan. To improve patients' long-term glycemic control, a continuous education is required.

Etiology and glycemic control among Thai children and adolescents with diabetes mellitus

BACKGROUND

There is little data on etiology and metabolic control in children and adolescents with diabetes in developing countries.

OBJECTIVE

Determine the etiology of diabetes in Thai youths and to evaluate their glycemic control.

MATERIAL AND METHOD

The authors retrospectively reviewed the case records of 157 patients seen at the Department of Pediatrics, Siriraj Hospital between 2003 and 2004.

RESULT

Type 1 diabetes (T1D) comprised 83%, type 2 diabetes (T2D) 13%, and other types 4%. GAD65 and IA-2 antibodies were positive in 63% and 61% of T1D patients, and 0% and 9% of T2D patients, respectively. There were an increasing number of new cases, both T1D and T2D, during the study period compared with a previous study conducted at the hospital. Mean HbA1c in T1D and T2D were 8.9 +/- 2.1% and 6.2 +/- 1.80%, respectively (p < 0.001).

CONCLUSION

Based on the present study, glycemic control appeared to be more satisfactory in T2D patients than those with T1D. Glycemic control among T1D patients was comparable to others in developed countries.